Outcomes after PDA ligation

A systematic review with a meta-analysis of studies that reported outcomes after PDA ligation in babies less than 32 weeks gestation included 40 studies for analysis (one was a randomized trial and the rest were cohort studies). Compared with medical treatment, surgical ligation was associated with a decrease in mortality, but with an increase in neurodevelopmental impairment, chronic lung disease and severe retinopathy of prematurity. No difference was detected in the composite outcome of death or neurodevelopmental impairment in early childhood. However most of the cohort studies had a significant risk of bias (particularly survival bias) and did not adjust for important confounders.